Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 10064-10070
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.10064
Low phase angle is associated with the development of hepatic encephalopathy in patients with cirrhosis
Astrid Ruiz-Margáin, Ricardo Ulises Macías-Rodríguez, Javier Ampuero, Francisco Javier Cubero, Luis Chi-Cervera, Silvia L Ríos-Torres, Andrés Duarte-Rojo, Ángeles Espinosa-Cuevas, Manuel Romero-Gómez, Aldo Torre
Astrid Ruiz-Margáin, Ricardo Ulises Macías-Rodríguez, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 México City, México
Astrid Ruiz-Margáin, Ricardo Ulises Macías-Rodríguez, Department of Internal Medicine III, University Hospital RWTH Aachen, 52074 Aachen, Germany
Javier Ampuero, Manuel Romero-Gómez, Unit for the Clinical Management of Digestive Diseases, Virgen del Rocio - Virgen Macarena University Hospital, 41009 Sevilla, Spain
Francisco Javier Cubero, Department of Immunology, Complutense University School of Medicine, 28040 Madrid, Spain
Luis Chi-Cervera, Silvia L Ríos-Torres, Aldo Torre, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City 14080, México
Andrés Duarte-Rojo, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Ángeles Espinosa-Cuevas, Department of Nephrology and Mineral Merabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City 14080, México
Author contributions: Ruiz-Margáin A, Macías-Rodríguez RUand Torre A contributed to study conception and design; Ruiz-Margáin A, Chi-Cervera L and Ríos-Torres SL contributed to data acquisition; Ruiz-Margáin A, Macías-Rodríguez RU, Ampuero J, Cubero FJ contributed to data analysis and interpretation, Ruiz-Margáin A, Macías-Rodríguez RU, Cubero FJ and Duarte-Rojo A contributed to writing the manuscript; Espinosa-Cuevas A, Romero-Gómez M, Ampuero J, Cubero FJ and Torre A contributed to editing, reviewing and final approval of the article; and Torre A provided the funding for the project.
Institutional review board statement: This study approved by the Institutional review board statement.
Clinical trial registration statement: This study was registerted in ClinicalTrials.gov with reference No. NCT02023177, found in the URL: https://ClinicalTrials.gov/ct2/show/NCT02023177?term=aldo+toore&rank=7.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aldo Torre, MD, MSc, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan C.P., México City 14080, Mexico. detoal@yahoo.com
Telephone: +52-155-54870900 Fax: +52-155-54870900
Received: August 9, 2016
Peer-review started: August 9, 2016
First decision: September 21, 2016
Revised: September 27, 2016
Accepted: October 30, 2016
Article in press: October 30, 2016
Published online: December 7, 2016
Processing time: 119 Days and 12.8 Hours
Core Tip

Core tip: Malnutrition in cirrhosis is a known risk factor for mortality and the development of complications. We used phase angle derived from bioelectrical impedance that reflects cachexia, the type of malnutrition seen in chronic diseases. We found an association between the presence of low phase angle and higher incidence of hepatic encephalopathy in the 48 mo of follow-up compared to the group with normal phase angle, demonstrating the importance of this complication. We proposed a nutritional marker that can predict the development of hepatic encephalopathy with the advantage of being a non-invasive, inexpensive and bedside method.